# ROBERT E WALL DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255402665
- **Authorized official:** ROBERT E WALL DDS (OWNER)
- **Authorized official phone:** (812) 265-5962

## Contact information

- **Practice address:** 753 W MAIN ST, MADISON, IN 47250-3150
- **Practice address phone:** (812) 265-5962
- **Practice address fax:** (812) 273-1085
- **Mailing address:** 753 W MAIN ST, MADISON, IN 47250-3150
- **Mailing address phone:** (812) 265-5962
- **Mailing address fax:** (812) 273-1085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12007187 | IN | Yes |

## Other

- **Enumeration date:** 11/10/2006
- **Last updated:** 08/22/2020